Cirrhosis is a condition characterised by the scarring of the liver caused by long-term damage. Cirrhosis may eventually lead to liver failure and death if untreated. Cirrhosis is commonly caused by chronic viral hepatitis infection, alcohol overuse, alcoholic liver disease and non-alcoholic fatty liver disease. Cirrhosis can be divided into two categories: compensated and decompensated. Compensated cirrhosis is considered a milder form of cirrhosis where patients exhibit no symptoms. Decompensated cirrhosis is a condition whereby the liver starts to have trouble functioning and patients start to develop symptoms. Patients with cirrhosis often present with cardiovascular disease as they share common risk factors such as obesity, diabetes and high blood pressure. Patients with heart diseases such as those with irregular and abnormally fast heart rate (atrial fibrillation) or heart attack are often treated with drugs to reduce the formation of blood clots (antithrombotic therapy) to prevent stroke and death. So far, no large-scale studies have been conducted in the UK to evaluate the net clinical benefit on antithrombotic use patients with cirrhosis. Our findings may be used to inform treatment strategies in cirrhotic individuals who are at risk of developing stroke.
Patients with cirrhosis were thought to be auto anti-coagulated causing increased bleeding risks. However, this view has been challenged as studies demonstrate that patients with compensated cirrhosis have a fairly normal coagulative function, which may become altered upon the worsening of liver disease. It is now recognised that patients with cirrhosis have higher risk of thrombotic rather than bleeding complications, and anticoagulation is used to reduce the rate of decompensation and improve survival outcomes. Patients with cirrhosis, particularly those with non-alcoholic fatty liver (NAFLD) cirrhosis, share common risk factors with cardiovascular diseases. Focusing on atrial fibrillation and ischaemic heart disease, we will employ linked primary care, secondary care and mortality data in England to investigate the health outcomes of cirrhotic patients undergoing antithrombotic (antiplatelet and anticoagulant) therapy. We will perform a large-scale propensity score analysis to match cases (patients undergoing antithrombotic therapy) to controls followed by time-dependent Cox modelling on a mortality (all-cause, cardiovascular, cancer and liver), liver disease and cardiovascular disease (e.g. ischaemic and haemorrhagic stroke) progression. Our research may inform decisions on whether thromboprophylaxis should be considered for patients with cirrhosis.
All-cause mortality, cause-specific mortality (such as cardiovascular mortality, cancer related mortality, liver related mortality), cardiovascular (stroke, acute coronary syndrome, cardiac arrest, heart failure and transient ischaemic attack) and liver disease progression (hepatic encephalopathy, ascites and varices).
Harry Hemingway - Chief Investigator - University College London ( UCL )
Alvina Lai - Corresponding Applicant - University College London ( UCL )
Aasiyah Rashan - Collaborator - University College London ( UCL )
Arturo Gonzalez-Izquierdo - Collaborator - University College London ( UCL )
Christopher Tomlinson - Collaborator - University College London ( UCL )
Constantinos Parisinos - Collaborator - University College London ( UCL )
Eloise Withnell - Collaborator - University College London ( UCL )
Jurgita Kaubryte - Collaborator - University College London ( UCL )
Michail Katsoulis - Collaborator - Farr Institute of Health Informatics Research
Sheng-Chia Chung - Collaborator - University College London ( UCL )
Stefanie Mueller - Collaborator - University College London ( UCL )
Wai Chang - Collaborator - University College London ( UCL )
Yen Yi Tan - Collaborator - University College London ( UCL )
HES Admitted Patient Care;ONS Death Registration Data